1/ There are a lot of takes that this omicron wave will bring us closer to “normal” in 2022 when COVID will become endemic and be “just like the flu.” A comparison with historical flu seasons shows just how far away this really is and how much longer we may need to go. 🧵
2/ The key societal question is what level of mortality & morbidity do we accept from COVID in the long run. If influenza is the right analogue, then this chart shows that COVID has broken well beyond the baseline and “epidemic” threshold of mortality of prior flu seasons.
3/ “Just like the flu,” you say?

Let’s drill into some US data:
* 11,707 weekly PIC (pneumo, influenza, COVID) deaths since Labor Day
* At the peak of Delta, ~18,000 weekly PIC deaths

This is 3-5x our pre-COVID flu baseline (~3,500 weekly deaths).

cdc.gov/flu/weekly/wee…
4/ The mortality rate could be viewed as a proxy for all sorts of decisions that individuals, companies, policymakers make to gauge how dangerous COVID is and what structural changes we need to make to protect lives.
5/ My heuristic is that things will feel “normal” when the mortality rate is <500 deaths per day (i.e., the pre-COVID flu baseline), which coincidentally was the rate last summer when we declared “independence” from COVID.
6/ A “new normal” of 500 deaths/day from endemic COVID would be a non-trivial loss to bear “forever” — this loss of life implies a structural change in our healthcare system and economy (@$10 M “value per statistical life”, this equates to a $1.8 trillion annual loss for the US).
7/ What will it take to reduce the mortality rate by >50-70%?
* Omicron ends up being less severe than Delta (yes, but…)
* The vax/booster rate increases materially (not happening fast enough)
* Oral therapies live up to their promise in real world (jury’s out)
8/ While omicron appears to be less severe on a per case basis, the sheer volume of new cases right now means the overall pool of people susceptible is much larger. Net-net, a lot of people are still dying from a “milder” variant.
9/ Omicron has not yet fully spread to the older, sicker segment of the population and the worst could be yet to come with more time.

cnbc.com/2021/12/29/cov…
10/ I already wrote about Paxlovid and why it may not be the silver bullet:
11/ And remember, we have already had remdesivir for a while now in our toolkit, which is comparable in efficacy to Paxlovid.
12/ Even if we manage to get the death rate down, the volatility of COVID surges must be lower for us to treat COVID as an endemic phenomenon. Each new variant has brought with it a surge in cases and hospitalizations that has stressed our healthcare system.
13/ The omicron “flash flood” phenomenon compounds the volatility with the sheer number of people who are getting sick at the same time — even when they aren’t sick enough to be hospitalized — a “soft lockdown” in effect. theatlantic.com/health/archive…
14/ Estimates of 60% of people getting sick from omicron (140 M people) in the next few months would be 4-5x the number of people who get sick with flu in a “normal” year.

usatoday.com/story/news/hea…
15/ The trillion-dollar question is whether the omicron wave will induce durable and strong immunity. After all of the data we have seen on waning immunity (both vaccine-based and natural), my bet is the immunity will be short-lived and/or weak.
16/ There are even signs of waning immunity in those who have so-called “super-immunity”

nature.com/articles/d4158…
17/ None of the above takes into account the unknown morbidity that comes from a COVID infection (or repeated infections over time). It would radically change the game if the risk of long COVID from omicron was found to be material.
18/ It is too late to impact this current wave, but we should be doing everything in our power over the next year to get ready for a similar (or more devastating) variant next fall.

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More from @cha_myoung

29 Dec 21
1/ The great hope right now is that the orals from @pfizer and @Merck are the “silver bullet” that will bring an “end” to omicron and the pandemic. These are amazing new Rx’s, but deploying them properly will be way harder than people think. 🧵
2/ We now have another weapon in the toolkit with oral pills that do not have the same burdensome requirements of mAbs. ~90% risk reduction from Pfizer’s Paxlovid in high-risk patients is indeed excellent. pfizer.com/news/press-rel…
3/ The FDA EUA for Paxlovid specifies that the treatment must be administered within 5 days of symptoms. The name of the game here is speed: the longer the treatment start is from symptom onset, the less impact these orals will likely have.
Read 18 tweets
27 Dec 21
1/ Lots of questions on why I think we could be in the early part of the COVID decade. Tons of focus right now on omicron, but not many talking about the long game. This isn’t a deterministic prediction but a scenario very few policymakers are willing to talk about openly. 🧵
2/ At almost every turn of this pandemic, numerous experts have declared that the end of the pandemic is near, if we can only hold on for a few weeks or months. This has raised a lot of false hope over the last couple years.
3/ With omicron, some experts are declaring that this last wave will spell the end of the pandemic in 2022.
Read 22 tweets
24 Dec 21
1/ With the omicron surge, I have had more friends send me screenshots of exposure notifications (EN) in the last week than I have in the last year. Here are some reflections based on the work I led at @Apple working with @Google and some thoughts on the road ahead. 🧵
2/EN was one of the most exciting projects I have ever worked on with an unbelievable amount of technical talent at both companies deployed to deliver in a matter of months. (Recent gathering of a small subset of the crew below)
3/ As we worked on the effort, it became clear to me that public health agencies did not fully grasp the power of the technology as a way to massively augment more traditional NPIs.
Read 25 tweets
21 Aug 21
1/ Some thoughts on the #healthcareishard theme from last week based on my recent experiences at @Apple and now at @CarbonHealth 👇🏻
2/ The struggle is real, but this is true for anyone trying to make a dent in healthcare, whether at a startup or a large tech company. So I agree with @chrissyfarr, the takeaway isn’t “Health care is hard.” Of course it’s hard.
3/ There are a few important things that make it different living inside a tech company (and quite frankly any large company) versus a startup:
Read 25 tweets
21 Aug 21
1/ Not many people would call healthcare a hyper-growth market, but @CarbonHealth has figured out a model that people love and a flywheel that few companies in healthcare have tapped into.
2/ Patient volumes have grown more than 100% in the last six months, most of which has been driven by consumer word of mouth and patients who come back to visit us.
3/ “At the height of the pandemic, the clinic saw as many as 120 patients in a day, almost all of them for Covid testing and treatment. Now they see maybe 60 patients per day, for everything from Covid tests to women's health to basic checkups.”
Read 4 tweets

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